Evidence-Based Medical Ethics:: Cases for Practice-Based Learning by John E. SnyderEvidence-Based Medical Ethics:: Cases for Practice-Based Learning by John E. Snyder

Evidence-Based Medical Ethics:: Cases for Practice-Based Learning

byJohn E. Snyder

Paperback | November 5, 2010

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In the modern practice of medicine, new challenges complicate the ethical care of patients. Today's times require a contemporary take on the concept of medical ethics. Regrettably, there are few books and learning tools available to bring medical ethics education into the 21st Century. Existing texts are not practical or user-friendly.This book aims to address what has been missing in existing text books and ethics courses to date: clear-cut ethical and legal guidelines essential to the everyday practice of medicine, modernization of the teaching material to include common dilemmas seen in medicine today, connection between ethical practice and current evidence-based medicine, correlation of ethics teaching with education in cultural competence, and a user-friendly, innovative, and interesting format. Together, the authors have already collaborated for the last few years to collect numerous "typical" examples of ethically complex cases. Similar real-life scenarios are seen at all medical institutions across the country, and practitioners need a teaching tool to help them approach such cases.In this textbook, the reader will find: (1) Twenty-five "typical" patient scenarios are presented and supplemented with questions for consideration by the reader or class, (2) Evidence-based medicine, legal precedent, and ethical theory applying to each patient scenario is discussed, (3) Ethical dilemmas are enlivened with age, gender, and culture issues, (4) A patient-centered approach to ethical dilemmas is presented, (5) Emphasis is made on the six "core clinical competencies" of medical education in the 'Formulation' section of each individual case (patient care, medical knowledge, practice-based learning and improvement, interpersonal skills and communication, professionalism, and systems-based practice), (6) The text includes a "medical boards"-style comprehensive exam to further challenge the reader and to assess their gained skills and knowledge. This book is written with several audiences in mind: medical students and residents, nursing students, pharmacy students, undergraduate and graduate students in medical ethics courses, and physicians desiring further training in medical ethics, cultural competency, communication skills, and medical board preparation.
Title:Evidence-Based Medical Ethics:: Cases for Practice-Based LearningFormat:PaperbackDimensions:254 pages, 9.25 × 6.1 × 0.07 inPublished:November 5, 2010Publisher:Humana PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:1617378828

ISBN - 13:9781617378829

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Table of Contents

Case-Based Medical Ethics in PracticePreface by the authorsForewordChapter 1: A brief introduction to medical ethics in Internal MedicineDefinitions of ethics and medical ethicsWhy is medical ethics important? (teaching competency in ethics, teaching professionalism)Evolution of medical ethics and its importance/role in modern medicine (from paternalism to informed consent)Who determines ethical guidelines for medicine?Difference/similarities between ethics and lawPurpose of the book (i.e. to stimulate thought and discussion, not cover all details of all ethical principles)Chapter 2: The underlying principles of ethical patient careBeneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.) Non-maleficence - "first, do no harm" (Primum non nocere). Autonomy - the patient has the right to refuse or choose their treatment (Voluntas aegroti suprema lex.) Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment. Dignity - the patient (and the person treating the patient) have the right to dignity. Veracity - the patient should not be lied to, and deserves to know the whole truth about his/her illness and treatment.Chapter 3: Putting ethics into practice - realities, limitations, and roadblocksPractitioners and personal belief systemsCultural competency and practice of ethical careStatement about pharmaceutical company influence on education and practiceMedical oaths - Are they valid for medicine today? Are they fulfilled by practitioners? The Patient Bill of RightsFederal, state, local, and institutional regulations - how they intertwine and affect each otherChapter 4: Advanced Directives, Living Wills, and the Health Care Power of Attorney (HCPOA)Chapter 5: Case-based ethical dilemmas How the reader should approach these casesWhere to find more information if needed Case 1Topic: Consent in the mentally ill or otherwise unfit (and 'in between' situations: delirium, psychiatric decompensation)Subtopic: When does forcing an incompetent patient to undergo treatment limit their right to dignity and the principle of 'do-no-harm'?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 2Topic: When the HCPOA neglects their responsibility, or has other personal interests/potential gains. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 3Topic: When the patient/their family bullies practitioners into unnecessary diagnostics/therapeutics"C.Y.A." medicine. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 4Topic: When an estranged family member or spouse suddenly appears to make decisions. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 5Topic: How to deal with an inpatient behaving badly (psych consults, behavioral contracts, room restriction etc.)OutburstsSubstance abuseIllegal activity (e.g. drug-dealing)Known criminal warrantsInappropriate actions or remarksAdmitted for ulterior motives (secondary psychologic gains, homelessness, etc.). Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 6Topic: When DSS consults are neededChild abuse/neglectElder abuse/neglectSpousal abuse. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 7Topic: When a patient has 'burned all bridges' and no discharge planning is possibleNo nursing home or rehab center will accept the patientNo home health services will accept the patient. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 8Topic: Can a practitioner refuse to admit a patient? To see a patient in the office (e.g. administrative discharge)?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 9Topic: When a patient makes 'bad' decisions (e.g. will accept some therapies and not others, such as some blood products but not others, some procedures but not others, DNI but not DNR, etc.)Does a practitioner follow the patient's wishes? Do they refuse to treat?Subtopic: When a patient is guided by incomplete, or misinformation (e.g. from the internet). Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principles  Case 10Topic: When a patient's same-sex partner has no legal rights and is excluded by a family. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 11Topic: When a patient has a contagious disease (e.g. HIV) and their partner is not awareSubtopic: When a partner/family does not have all the information needed to make decisions for a patient (e.g. when to disclose diagnoses such as HIV-positivity, substance abuse, suicidality)Subtopic: When confidential information is inadvertently leaked to those who 'don't need to know'Subtopic: What diseases are 'reportable'?Subtopic: Do patients avoid testing for confidentiality fears?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 12Topic: When a family will not accept a terminal prognosis (i.e. futile 'full codes')Should a family be present during the code?Subtopic: When a patient themselves is unrealistic about prognosisSubtopic: When is a patient 'terminal'? (i.e. definition of brain death)Subtopic: When is it appropriate to change the focus of care to comfort/hospice? How do a practitioner's personal beliefs affect this guidance?The concept of dignity/therapeutic death v. Euthanasia. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 13Topic: When there is no one to make decisions for a patient (e.g. John/Jane Doe in ICU, wards of the state). Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 14Topic: When a mistake has been made by a practitioner (what/how to/how much to disclose)Mistake by primary practitioner; mistake by other/outside practitionerSubtopic: Caring for a patient after a poor outcome or mistake (i.e. how is care affected)Subtopic: When a patient makes a reference to a grievance or verbally disparages another practitioner. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 15Topic: When what a patient needs cannot be obtained (e.g. financial/insurance limitations)Tests/procedures (e.g. colonoscopy in an uninsured/pre-Medicare patient aged 50 to 64 years old)TreatmentsA different medical team ("I want a new doctor"), especially when no others will take your "difficult" patient. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 16Topic: When next-of-kin (NOK) disagree with each otherSubtopic: Which of the NOK has 'seniority'? Are legal definitions for NOK equivalent to ethically 'best' choices?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 17Topic: When a toxicology screen is ordered without patient consent and comes back positiveSubtopic: When tests are ordered 'in emergency situations' without patient consent (e.g. HIV tests)Subtopic: When a practitioner is potentially exposed to infectious agents (e.g. via a needlestick) and a patient is refusing further testing. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 18Topic: When a patient 'signs out against medical advice' Practitioner obligationsHow can competence be quickly assessed and assured?What about a patient with contagious disease (e.g. TB)? Can they be allowed to leave?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 19Topic: When a patient requests a clinical interaction be recorded. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 20Topic: When a family member requests patient information not be shared with the patient, or with other persons . Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 21Topic: When a patient requests to not be seen by a (specific, or any) medical resident or student. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 22Topic: When a patient requires or demands large amounts of time from a practitioner. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 23Topic: How to prescribe medications to someone who has attempted suicide (e.g. with pills)Subtopic: How to accurately assess and document safety in a depressed patient. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 24Topic: When a colleague demonstrates suspicious behaviorMemory problemsSubstance abuseOutburstsInappropriate relationships with or behavior toward patients, coworkers, etc.Dishonesty. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 25Topic: When a language translator is not available (or only a family member/hospital employee is). Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 26Topic: When a patient is repeatedly readmitted to the hospital due to non-adherence (e.g. with therapy, diet, etc.)Where does a patient's responsibility for their own care and well-being begin? The 'cry wolf' syndromeShould a procedure be repeated if a patient's behavior may have caused failure of the first one?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 27Topic: When lawyers or law enforcement want to know patient information (HIPAA/confidentiality and the law)Blood alcohol level or toxicology testingRape exam resultsHidden drug stores (e.g. body cavities)When should access to a crime victim be allowed? To a suspected perpetrator?What right to privacy do prisoners have with regard to history, physical exam? Can/should discharge plans be shared with prisoners?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 28Topic: When a patient requests disability certification, handicap plates, etc. - or when they request renewal of a revoked driver's license (e.g. can a practitioner-patient relationship be maintained when a patient doesn't get what they want?). Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 29Topic: How much resources should be spent on a single patient's case? (i.e. public health cost v. value of human life)Subtopic: When do you stop looking for answers to a patient's 'mystery problem'?Subtopic: When if ever do you call a case futile based on cost/public burden of care?Subtopic: What resources need to be made available at a hospital for 'rare' situations or patients?MRI for the morbidly obeseMale Pap smear equipment. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 30Topic: How much information must a practitioner share with a patient?Explanation of logic for decisions/opinion/treatment plan, explanation of test resultsExplanation of all potential side-effectsHow much information is needed for 'informed consent'?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 31Topic: How to deal with a patient seeing two or more practitioners (same specialty, overlapping meds, etc.). Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 32Topic: How to manage chronic pain (e.g. are 'pain contracts' ethical?; how is pain objectively assessed?). Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 33Topic: At what age, if any, do you stop health maintenance disease screening?Subtopic: At what age, if any, to you stop invasive procedures? Placing pacemakers?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 34Topic: When can a practitioner withhold therapy from a patient based on their behavior?Examples: HAART therapy for HIV, HepC treatment, anti-coagulationBehavior: Non-adherence to therapy, substance use/abuse, continued tobacco use/abuseSubtopic: When does a patient qualify for a transplant? Is 6 months sobriety appropriate?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 35Topic: When a Jehovah's witness needs a blood transfusionAre blood substitutes allowed? Should surgery/organ transplantation be withheld if transfusion will not be allowed by the patient?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principlesCase 36Topic: How far does screening go?Breast cancer genes, hypercoaguability work-up in family members of a patient with a new diagnosisWill this lead to insurance decisions re: 'pre-existing conditions'?. Narrative of clinical scenario with specific example of ethical dilemma. Questions for thought/discussion. Explanations of underlying ethical and legal principles Comprehensive ExamSuggested reading and internet resourcesGlossary of termsIndex

Editorial Reviews

From the reviews:"Fictional case records that encapsulate many of the problems encountered frequently by comprehensive therapists become the basis for this nice, inexpensive, little manual. . It becomes an easy reading monograph that can be appropriately sampled as time permits and will spare time when similar cases are encountered in clinical practice." (William H Wehrmacher, Comprehensive Therapy, December, 2008)"This is the newest addition to case-based clinical ethics books. ... the purpose of this book is `to provide a method for the reader to learn how to systematically manage dilemmas seen in the everyday practice of medicine.' The authors ... have several audiences in mind for the book: medical students and residents, nursing students, undergraduate and graduate medical ethics courses, as well as clinicians." (Michele K. Langowski, Doody's Review Service, November, 2008)"Synder and Gauthier have taken a very interesting, and surprisingly seductive, approach to teaching medical ethics. . the book would be a valuable addition to many bookshelves." (Ruth Wilkinson, Public Health Ethics, January, 2009)